Economic evaluation of micafungin versus caspofungin for the treatment of candidaemia and invasive candidiasis

Authors


  • Funding: This study was not supported by any pharmaceutical company. The study was partly funded by the scholarship to C. F. Neoh from the University of Technology Mara.
  • Conflicts of interest: D. Liew has sat on advisory boards for and received honoraria from Pfizer, although not in relation to antifungal therapies. M. A. Slavin and S. C.-A. Chen have sat on advisory boards for and received research funding from Pfizer, Merck, Schering-Plough and Gilead Sciences. D. Liew has sat on advisory boards for Merck and Gilead Sciences and received research funding from Pfizer and Merck. O. Morrissey has sat on advisory boards, received investigator-initiated grant support from and given lectures for Gilead Sciences, Pfizer, Merck, Schering-Plough and Orphan Australia. D. C. M. Kong has sat on advisory board for Pfizer and receives financial support from Pfizer, Merck and Gilead Sciences. All other authors: None.

Correspondence

David CM Kong, Centre for Medicine Use and Safety (Monash University), 381 Royal Parade, Parkville, Vic. 3052, Australia.

Email: david.kong@monash.edu

Abstract

Background

Micafungin demonstrated non-inferiority to caspofungin as definitive therapy for candidaemia and invasive candidiasis (IC) in a major randomised clinical trial.

Aim

The aim of this study was to investigate if micafungin is a cost-saving option compared with caspofungin for treating candidaemia and IC.

Methods

A decision analytical model was constructed to capture downstream consequences of using either agent as initial therapy for candidaemia and IC. The main outcomes were treatment success and treatment failure (i.e. death, mycological persistence, emergent infection, clinical failure but microbiological success). Outcome probabilities and treatment pathways were derived from the literature. Cost inputs were from the latest Australian resources, and resource use was estimated by expert panel. The analysis was from the Australian hospital perspective. Sensitivity analyses using Monte Carlo simulation were conducted.

Results

Micafungin (AU$52 816) was associated with a lower total cost than caspofungin (AU$52 976), with a net cost-saving of $160 per patient. This was primarily due to the lower cost associated with alternative antifungal treatment in the micafungin arm. Hospitalisation was the main cost-driver for both arms. The model outcome was most sensitive to the proportion of treatment success in the micafungin arm. Uncertainty analysis demonstrated that micafungin had a 58% chance of being cost-saving compared with caspofungin.

Conclusions

Micafungin was cost-equivalent to caspofungin in treating candidaemia and IC, with variation in drug acquisition cost the critical factor.

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